JIM Today 2018 - Friday - page 8

JIM today
Issue 2 
 23 February 2018
Karl Heinz Kuck, Roxana Mehran,
Hendrik Treede
Online factoids relevant to the cases presented:
Francesco Giannini (Coordinator),
Gianmarco Iannopollo, Antonio Mangieri
Discussing the case
Evening Symposia
Room Manzoni
Complications in interventional
cardiovascular therapies
Why did it happen, How did you manage
it, How will you prevent it in the future
with the support of Complex Interventional
Cardiovascular Therapy (CICT)
Chairpersons: Issam Moussa, Joseph DeGregorio
Coronary interventions complications
18.30 Case 1
Case presentation Joseph DeGregorio
Case discussion
18.45 Case 2
Case presentation Goran Stankovic
Case discussion
Structural heart disease interventions
19.00 Case 1
Case presentation Bernhard Reimers
Case discussion
19.15 Case 2
Case presentation Carlo Briguori
Case discussion
Vascular interventions complications
19.30 Case 1
Case presentation Bernhard Reimers
Case discussion
19.45 Case 2
Case presentation Issam Moussa
Case discussion
Left Main Conclave
Room Club
Chairperson: Antonio Colombo
Panel: Martin B. Leon, Jeffrey Moses,
Gregg W. Stone
Learn from the experts. Left main
bifurcation: where are we today?
Guidelines, decision making and strategies
Alaide Chieffo
Managing an acute occluded
LM Balbir Singh
Rotablation in left main bifurcation
Purshotam Lal
LM stenting: be prepared for the worst
T.S. Kler
Distal LM with bifurcation
Rishi Gupta
Distal LM with trifurcation
S.K. Reddy
Impact of imaging in LM PCI
Anand Gnanaraj
Optimizing LM bifurcation lesion
Murugesh S. Hiremath
Antonio Colombo
think the expectations of industry and the stock
market were that this was going to be a quick and
easy win, like TAVI, with even more patients. But,
the device industry and
clinicians are now learning
that mitral valve replace-
ment is a much more com-
plicated nut to crack.
The numbers are
growing but compared
with TAVI, we are still
talking about a tiny slice
of the market. We are still
seeing small numbers of
highly selected patients.
For instance, the number
for the Tendyne valve [Ab-
bott Vascular, USA] is now
around 120, and for the Intrepid valve [Medtronic,
USA], only about 80 or 90.
What are the challenges of mitral valve re-
The valve is often not very calcified, so implant-
ing a device is challenging in terms of its stabil-
ity. Additionally, the anatomy and pathology of
mitral valve disease is very varied, so individual
patients usually present individual combinations
of problems. Then there are hazards associated
with putting a big device in the mitral position.
Firstly, there’s the potential for left ventricular
outflow tract obstruction; secondly, it is in a
fairly thrombogenic position in contact with
the left atrium, so the risk of thrombosis
is quite high. And finally, at the moment,
access to carry out a procedure virtually
always requires a transapical approach - a
large tube and a large hole, which can be
quite a big insult for the patient.
Are there any other issues?
I also want to mention the concept of
screening fatigue, whereby just one in
every 10 or even 20 patients that are
considered for these devices is subsequently
found to be suitable. That’s a lot of effort
and patient expectation that goes nowhere.
You say to a patient, “There is a possibility of
a new device, we are going to consider you,
conduct lots of tests and put it through an expert
screening committee and we hope that it will be
something that will help you.” If nine times out of
10 the answer comes back “No, sorry, not suit-
able,” that’s quite a disappointment for
the physician and the patient.
What would you like to see in the future?
We would like to see more evidence and more
publications rather than just abstracts and oral
presentations. We need peer-reviewed data. We are
ultimately going to need
some randomised trials
comparing percutaneous
mitral valve replacement
with repair technology
and medical treatments –
some of these are already
underway. I think a big
technical step forward will
be when we are able to
do these procedures via
transseptal approach rather
than transapical. That’s not
far away for some of the
devices. It’s all to do with
the size and steerability of the delivery systems to
get the devices where they need to be.
So would you say that mitral valve replace-
ment is not ready for prime-time yet?
One may draw that conclusion, and I can’t disagree.
There is a long journey yet ahead and it’s not all go-
ing to be easy. The road might be bumpy and there
are going to be some downs as well as ups.
Structural Heart 2 
Continued from page 6
Continued from page 7
Mitral valve replacement ready for prime time?
“We are ultimately going
to need some randomised
trials comparing
percutaneous mitral valve
replacement with repair
technology and medical
Bernard Prendergast
“The number of patients with mitral regurgitation
is potentially very large, but the challenge we
face is that the mitral valve is a much more
complicated entity than the aortic valve.”
Bernard Prendergast
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